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General NPI Number Information
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NPI Number | 1679170203
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Entity Type | Organization
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Legal Business Name | LOTUS THERAPY GROUP INC
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 112 KANSAS ST
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City | FRANKFORT
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State | IL
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Zip | 60423-1447
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Country | US
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Telephone | 708-552-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 112 KANSAS ST
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City | FRANKFORT
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State | IL
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Zip | 60423-1447
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Country | US
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Telephone | 708-552-7330
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Fax |
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Authorized Official
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Title or Position | LEAD DIETITIAN, CO-OWNER
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Name | LISA CARROLL
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Credential | MS, RD, LDN
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Telephone | 708-552-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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